Provider Demographics
NPI:1821141326
Name:DAHL, WILLIAM K (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:K
Last Name:DAHL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5064
Mailing Address - Country:US
Mailing Address - Phone:207-945-5554
Mailing Address - Fax:207-945-5196
Practice Address - Street 1:205 FRENCH ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5064
Practice Address - Country:US
Practice Address - Phone:207-945-5554
Practice Address - Fax:207-945-5196
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD200213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME220000000Medicaid
ME010476684OtherFED I D NUMBER
MET79477Medicare UPIN
MEMM2240Medicare ID - Type Unspecified